Findings From the National Cancer Opinion Survey: Alternative Therapies, Cost of Care, and More

Nearly 4 in 10 Americans believe cancer can be cured solely through alternative therapies, according to ASCO's second annual National Cancer Opinion Survey. This is despite research showing that patients who use alternative therapies instead of standard cancer treatments have much higher mortality rates. The survey also found that amid the ongoing opioid crisis, nearly three in four Americans are opposed to limiting access to opioids for people with cancer, and many patients with cancer report difficulty obtaining these medications. In addition, just as many Americans say they are worried about the financial impact of a cancer diagnosis as about dying of cancer, with caregivers and rural Americans bearing the weight of cancer's financial and access challenges.

The National Cancer Opinion Survey is a large, nationally representative survey conducted online by The Harris Poll.

"This survey serves as a barometer of the American people's views on important cancer-related issues," said ASCO President Monica Bertagnolli, MD, FACS, FASCO. "It's revealed a number of critical areas we urgently need to address—from correcting widespread misinformation about cancer treatments, to ensuring patients have access to the pain medication they need, to alleviating the financial distress both patients and their loved ones experience too frequently."

The national survey, commissioned by ASCO, was conducted online by The Harris Poll from July 10–August 10, 2018 among 4,887 American adults ages 18 and older. Of these adults, 1,001 have or had cancer.

Alternative Therapies

Thirty-nine percent of those surveyed believed cancer can be cured solely through alternative therapies such as enzyme and oxygen therapy, diet, vitamins, and minerals. However, according to a recent study published by Johnson et al in the Journal of the National Cancer Institute, patients with common cancers who chose to treat them using only alternative medicine had a 2.5 times higher mortality rate than patients who received standard cancer treatments such as surgery, radiation, chemotherapy, immunotherapy, and hormone-based therapies.

Even many of those with direct cancer experience—people who have or had cancer and family caregivers—believed cancer can be cured solely through alternative medicine (22% and 38% respectively). The survey also found that younger people—47% of people ages 18–37 and 44% of people ages 38–53—are the most likely to hold these views.

"There's no question that evidence-based cancer therapy is necessary to effectively treat the disease," said ASCO Chief Medical Officer Richard L. Schilsky, MD, FACP, FASCO. "The vast majority of alternative therapies either haven't been rigorously studied or haven't been found to benefit patients. When patients are making critical decisions about which cancer treatments to undergo, it is always best to follow the evidence from well-designed research studies."

Financial and Access Challenges in Cancer

If faced with a cancer diagnosis, 57% of Americans say they would be most concerned about either the financial impact on their families or about paying for treatment, compared to 54%, each, who say they would be most concerned about dying or about cancer-related pain and suffering.

Even more than patients, family caregivers bear the brunt of the high cost of cancer treatment:

Among caregivers responsible for paying for cancer care, nearly three in four (74%) say they're concerned about affording it.

More than 6 in 10 caregivers (61%) say they or another relative have taken an extreme step to help pay for their loved one's care, including dipping into savings accounts (35%), working extra hours (23%), taking an early withdrawal from a retirement account or college fund (14%), postponing retirement (14%), taking out a second mortgage or other type of loan (13%), taking on an additional job (13%), or selling family heirlooms (9%).

"Patients are right to be concerned about the financial impact of a cancer diagnosis on their families. It's clear that high treatment costs are taking a serious toll not only on patients but also on the people who care for them," said Dr. Schilsky. "If a family member has been diagnosed with cancer, the sole focus should be helping them get well. Instead, Americans are worrying about affording treatment, and in many cases, they're making serious personal sacrifices to help pay for their loved ones' care."

Rural Americans are the most likely to be concerned about the availability of cancer care near where they live:

Four in 10 rural Americans who have or had cancer (40%) say there aren't enough doctors specializing in cancer care near their home, compared to 22% of urban and suburban patients.

Rural patients typically spend 50 minutes traveling one way to see their cancer doctor vs 30 minutes for nonrural patients.

"The unfortunate reality is that rural Americans routinely have to travel long distances for cancer care, which can lead to dangerous delays in their diagnosis and treatment," said Dr. Bertagnolli. "As a result, rural counties have higher death rates from many common cancers than urban areas. Our health-care system needs to address these disparities so that every patient, no matter where they live, can access high-quality cancer care."

Opinions on Use of Opioids and Medical Marijuana for Patients With Cancer

Most Americans believe that patients with cancer should not have their access to opioids curtailed amid efforts to curb the opioid epidemic: 73% say any new rules and regulations that make prescription opioids harder to obtain should not apply to patients with cancer.

Yet, the survey shows that accessing opioids for cancer pain is already difficult for many people with cancer. In a small sample, 40% of patients with cancer who have used opioids in the past 12 months to manage pain or other symptoms have had trouble accessing them.

"People with cancer frequently experience severe pain and many of them require opioids to treat it," said Dr. Bertagnolli. "Americans seem to recognize that…patients' access to needed pain medication should not be restricted, even as our country grapples with how to tackle the opioid crisis."

According to the survey, the vast majority of Americans (83%) support the use of medical marijuana among people with cancer. However, 48% of a small sample of patients who have used medical marijuana in the past 12 months say they have had difficulty obtaining it.* In addition, 58% of people who have or had cancer say they wish more information were available about the benefits of medical marijuana for symptom relief.

Government Action

Regardless of political affiliation, Americans want the government to take action in several key areas, including lowering the cost of prescription drugs. For example:

86% say the government should regulate the price of cancer drugs to help lower their cost.

77% say it should be legal for U.S. residents to buy cancer drugs from pharmacies in other countries.

In addition, Americans are calling for greater investment in cancer research, screenings, and care, even if it means higher taxes or adding to the deficit:

Two in three Americans (67%) say the government should spend more money to develop cancer treatments and cures.

Over half of Americans (58%) think the government should spend more money to help Americans afford cancer screenings and care.

Still, the overwhelming majority of patients with cancer are happy with the care they have received: nearly 9 in 10 people with cancer believe they are receiving/have received the best possible cancer care (89%) and are satisfied with the quality of the doctors who specialize in cancer care near where they live (88%).

*Small base (< 100). Results are suggestive but not definitive.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.

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